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PURPOSE Malignant fungating wounds (MFWs) afflict up to 14% of patients with advanced cancer. The bacterial community structures of MFW may influence the development and severity of wound symptoms. The purpose of this systematic review was to evaluate existing evidence regarding the relationship between microbiome and symptoms of MFWs. METHODS A systematic review of the published literature from January 1995 to January 2020 was conducted. An established quality assessment tool was used to assess the quality of the included studies. SEARCH STRATEGY We searched 4 major electronic databases and retrieved 724 articles; 7 met inclusion criteria. FINDINGS/CONCLUSIONS Seven studies were included; the overall quality of the included 7 studies was ranked as adequate. Findings from the studies provided an incomplete characterization of the microbiome and metabolome of MFW; none included modern genomic technologies. Twenty different species of aerobes and 14 species of anaerobes were identified, with inconsistent identification of biofilms and multi-drug-resistant bacteria. Symptom occurrence increased with the number of bacteria species (P = .0003) and the presence of at least 1 anaerobe (P = .0006) in malignant wound beds. Cancer wound-derived odor was associated with dimethyl trisulfide and 4 fatty acid volatiles. Periwound and moisture-associated skin damage were associated with higher putrescine levels in exudates. IMPLICATIONS Understanding the role of microbiota of MFW in developing or amplifying the severity of wound symptoms is the first step toward development of more precise and effective topical interventions.

Purpose This study aimed to examine factors associated with reported infection and symptoms among individuals with extremity lymphedema. Design A cross-sectional study was used. Methods Data were collected from a survey supported by the National Lymphedema Network from March 2006 through January 2010. A total of 1837 participants reported having extremity lymphedema. Logistic regression analyses were used. Findings Factors associated with reported infection among individuals with extremity lymphedema included male gender, decreased annual household income, decreased self-care, self-report of heaviness, and lower extremity as opposed to upper extremity. Factors associated with symptoms included infection, decreased self-care, lower knowledge level of self-care, decreased annual household income, and presence of secondary lower extremity lymphedema. Conclusions/Clinical Relevance Select factors of income, self-care status, and site of lymphedema were associated with increased occurrence of infection and symptoms among individuals with extremity lymphedema. Longitudinal studies are needed to identify risk factors contributing to infections and symptoms in individuals with lymphedema.

Background Little is known about the effectiveness of activities used to self-manage lymphedema. Objective The aim of this study was to evaluate the level of evidence of peer-reviewed lymphedema self-care literature published from January 2004 to May 2011. Methods Eleven major medical databases were searched. Articles were selected for inclusion or exclusion into the category of self-management of lymphedema by topic experts. The definition of self-management included activities that individuals initiate and perform for themselves without the assistance of others. Articles were scored according to the Oncology Nursing Society's Putting Evidence Into Practice levels of evidence. Results Sixteen articles met criteria for inclusion in this review, with self-management as the independent variable. Ten categories of self-management were established subsequently and articles were classified by levels of evidence. In these categories, no self-management studies were rated as "recommended for practice," 2 studies were rated "likely to be effective," none was rated "benefits balanced with harms," 7 were rated "effectiveness not established," and 1 was rated "effectiveness unlikely." Discussion Few studies included measures of outcomes associated with lymphedema, and there was a scarcity of randomized controlled trials in lymphedema self-management. A demonstrated need exists for the design and testing of self-management interventions that include appropriate outcome measures.

Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide, causing about 1 million deaths annually. Patients with HCC usually reported multiple concurrent symptoms. The purpose of this multivariate study was to explore whether multiple concurrent symptoms are clustered into groups of symptoms and to explore the effect of symptom clusters on the quality of life (QOL) in patients with HCC. A sample of 180 patients with HCC at a medical center in Korea was recruited. Patients completed a demographic questionnaire, a Symptom Checklist, the Hospital Anxiety and Depression Scale, and the Functional Assessment of Cancer Therapy-Hepatobiliary. Factor analysis was used to identify symptom clusters based on the severity of patients' symptom experiences. Four symptom clusters were identified: pain-appetite, fatigue related, gastrointestinal, and itching-constipation. Two patient subgroups were identified through cluster analysis: high- and low-symptom group. Patients in the high-symptom group had significantly poorer functional status and poorer QOL in all the domains, with the exception of social well-being. The differences between the 2 patient subgroups were not only statistically but also clinically significant. Patients in the high-symptom group were also statistically and clinically anxious and depressed. Further research is needed to explore whether compositions of symptom cluster phenotypes vary over time and whether the associations of symptom clusters with QOL and mood are changing along the disease and treatment trajectory as well as symptom status.

This descriptive, cross-sectional, correlational study with a convenience sample of 96 women treated for breast cancer at an outpatient service in Brazil was designed to investigate post-lymphadenectomy complications after axillary lymph node dissection (ALND) and sentinel lymph node biopsy and explore the associative relationships between the complications and quality of life. Clinical evaluations using perimetry, goniometry, and muscle strength test were used to evaluate the complications. Pain and quality of life were assessed by the Short-Form McGill Pain Questionnaire and the Functional Assessment of Cancer Therapy-Breast. All participants had at least one complication. Incidence was higher for pain (57%), impaired shoulder strength (57%), and fibrosis (54%), followed by impaired shoulder range of motion (46%) and lymphedema (17%). The incidence of impaired shoulder flexion (P = .01) and lymphedema (P = .002) was higher in ALND group. Winged scapula (8.4%) only occurred in the ALND group. Quality of life was significantly correlated with pain (r = -0.53, P = .000) and impaired shoulder strength in flexion (r = 0.4; P = .000) and abduction (r = -0.5, P = .000). Future studies are needed to prospectively investigate the onset of the complications and identify appropriate interventions to promote quality of life in women treated for breast cancer.

The purpose of this study was to determine reliability and validity of the Chinese version of the Index of Nausea, Vomiting, and Retching (INVR) and the Index of Nausea and Vomiting Form 2 (INV-2) to provide a reliable and valid measure of nausea, vomiting, and retching for Chinese nurses and other healthcare providers. An integrative translation method was used in the study. The reliability and validity of the Chinese versions of the INVR and the INV-2 was evaluated using test-retest, parallel forms, and crossover design. A convenience sample of 177 Chinese-speaking participants was accrued from a large teaching cancer institute and a teaching obstetric hospital in Beijing, Peoples Republic of China. The integrative translation method was proven to be an effective method for translating instruments from the source to the target language. The Chinese versions of both the INV-2 and INVR were found to have high Cronbach's alpha scores and high agreement rates. The responses to the Chinese version of INVR were more frequently consistent than the responses to the INV-2. The majority of the patients voiced preference for the INVR. The findings suggest the significance of the Chinese versions of INVR and INV-2 in terms of nursing practice. The findings also support the cross-cultural method for future study at international level.